Abstract
This treatise of chronic kidney disease (CKD) describes association of hypertension, diabetes and congestive heart failure (CHF) with CKD. CKD is defined by estimated glomerular filtration rate (eGFR) of less than 60 ml/min for three months or more. CKD is generally irreversible but not necessarily progressive. Thus progression of CKD into end stage renal disease (ESRD) is the concern here and what can be done to reduce the progression of CKD. Exact data of CKD with progression are unavailable but high incidence of ESRD (dialysis) eleven times more in 2011 than in 1980 accordingly to United States (US) Renal Data System is a testimonial to progression of CKD in patients with diabetes, hypertension, CHF and other renal diseases. US Renal Data System reveals that ESRD has soared in parallel with marketing of angiotensin converting enzyme inhibitor (ACEI) and angiotensin receptor blocker (ARB) drugs, providing strong indirect evidence that these drugs are someway instrumental in the progression of CKD into ESRD. These drugs produce acute renal failure which is an independent risk factor for CKD. Thus shift in therapy with enthusiastic use of ACEI/ARB drugs has led to dialysis bonanza throughout the world benefiting the professionals and corporations at the expense of vegetative life of the patients associated with family and societal burdens. The ways to turn the pendulum is to treat diabetes with insulin and hypertension with beta blocker, calcium channel blocker and diuretic therapy, and avoid the use of ACEI/ARB drugs. It is important to understand that diuretic orally, by intravenous boluses or by continuous infusion, is the cornerstone of therapy for CHF, whereas ACEI/ARB drugs markedly impair the efficacy of diuretics by lowering the blood pressure to a very low level thereby reducing renal perfusion. An evidence for that is marked elevation of BUN with comparatively slight increase of serum creatinine. Thus with the approaches stated above, CKD is less likely to progress; hence rate of ESRD is likely to decrease.
Highlights
chronic kidney disease (CKD): CKD or chronic renal failure is defined as irreversible renal failure which may or may not be progressive depending on circumstances and therapeutic approaches
CKD is defined as the presence of Kidney damage associated with glomerular filtration rate (GFR) of less than 60 ml/min/1.73 m2 for 3 or more months irrespective of cause [2]
Renal function is determined by measurement of serum creatinine and estimated glomerular filtration rate
Summary
Data from US ESRD Program The prescribers order microalbumin to determine the effect of ACEI/ARB therapy Seldom do they order renal function tests in particular GFR in the form of creatinine clearance. A 67 years African American female was referred to the author for decreased creatinine clearance She gave a history of diabetes for 12 years and was treated with glyburide. He went to urgent care clinic in December 2013 for routine physical exam and was told that he had very low kidney function and sent to hospital for investigation He gave history of diabetes for 20 years and was treated with metformin and glyburide. He was put on maintenance hemodialysis and cardiac catheter study was done which showed extensive coronary artery disease This patient demonstrates that his diabetes care was poor which permitted him to develop extensive atherosclerosis and ESRD.
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